Evidence Development & Decision Science

The systematic production and application of medical knowledge to clinical practice. LDI Senior Fellows analyze the process by which data affect coverage and clinical decisions, and conducts comparative effectiveness and cost effectiveness studies.

Effect of Attending Practice Style on Generic Medication Prescribing by Residents in the Clinic Setting: An Observational Study

Sep. 17, 2015

Kira L. Ryskina, C. Jessica Dine, Esther J. Kim, Tara F. Bishop, Andrew J. Epstein

In the Journal of General Internal Medicine, Kira Ryskina and colleagues, including Jessica Dine and Andrew Epstein, assess whether the prescribing practices of attending physicians influence residents’ likelihood to prescribe brand-name medications. The authors assessed the effect of the supervising attending’s rate of brand-name prescribing in the preceding quarter on the likelihood of a resident prescribing a brand-name statin. After adjusting for patient-, physician-, and practice-level factors, the supervising attending’s brand-name prescribing rate in the quarter preceding...

Uptake and Impact of a Clinical Diagnostic Decision Support Tool at an Academic Medical Center

Aug. 24, 2015

John S. Barbieri, Benjamin French, Craig A. Umscheid

In Diagnosis, John Barbieri, Benjamin French and Craig Umscheid investigate whether the use of a differential diagnosis (DDX) generator within a health care system leads to an increase in unnecessary testing and specialty consultation. By providing access to a broad differential, DDX generators can potentially help clinicians overcome cognitive biases by directing them to diagnoses they might not have considered otherwise. However, as the tool suggests numerous potential diagnoses, its use could result in an increase in unnecessary testing and specialty consultation, and...

Variability Among US Intensive Care Units in Managing the Care of Patients Admitted With Preexisting Limits on Life-Sustaining Therapies

Jun. 1, 2015

Joanna Hart, Michael Harhay, Nicole Gabler, Sarah Ratcliffe, Caroline Quill, Scott Halpern

In JAMA Internal Medicine, Scott Halpern and colleagues investigate variance in end-of-life care in intensive care units (ICUs) by looking at a group of patients with presumably similar care preferences. The authors compared the care received at 141 ICUs by patients with pre-existing limits on life-sustaining treatments, and the proportions of such patients who received aggressive care. The care outcomes measured were: provision of cardiopulmonary resuscitation, new forms of life support, and the addition or removal of treatment limitations. Of the ICU admissions evaluated, 4.8% of...

Suggestibility of Oncologists’ Clinical Estimates

May. 1, 2015

David I. Shalowitz, John O. Schorge

In JAMA Oncology, David Shalowitz and John Schorge (Massachusetts General Hospital), assess the degree to which oncologists’ clinical estimates might be biased by extraneous information. For their study the authors sent surveys of different clinical scenarios to members of the New England and Mid-Atlantic Association of Gynecological Oncologists. Respondents were asked to assess the scenarios and provide an estimated life expectancy, evaluate other providers’ assessments, and indicate what treatments they would opt for. Results of the study show that clinicians are influenced by anchoring...

Predictors of Community Therapists’ Use of Therapy Techniques in a Large Public Mental Health System

Apr. 1, 2015

Rinad S. Beidas, Steven Marcus, Gregory A. Aarons, Kimberly E. Hoagwood, Sonja Schoenwald, Arthur C. Evans, Matthew O. Hurford, Trevor Hadley, Frances K. Barg, Lucia M. Walsh, Danielle R. Adams, David S. Mandell

In JAMA Pediatrics, Rinad Beidas and colleagues explore the effects of individual and organizational characteristics on therapists’ self-reported use of different therapy techniques - cognitive behavioral therapy (CBT), family therapy, and psychodynamic therapy techniques. The study focuses on the Philadelphia public mental health system, currently engaged in a large-scale effort to increase the use of CBT. The study results show that although both individual and organizational factors are important, the relative significance of the factors varies by treatment type. Key findings include...

The Role of Training Environment Care Intensity in US Physician Cost Consciousness

Mar. 1, 2015

Kira L. Ryskina, Scott D. Halpern, Nancy S. Minyanou, Susan D. Goold, Jon C. Tilburt

In Mayo Clinical Proceedings, Kira Ryskina and colleagues, including Scott Halpern, evaluate the impact of training environment on physicians’ levels of cost-consciousness. The authors analyzed results from the Physicians, Health Care Costs, and Society survey, administered to physicians across the country in 2012. Using responses from physicians for whom information was available about the care intensity of the hospitals where they did their residency, the authors evaluated the degree to which training environment influenced the views expressed in the survey. Training intensity was...

Comparison of HIV Outcomes for Patients Linked at Hospital Versus Community-Based Clinics

Mar. 1, 2015

Asher J. Schranz, Kathleen A. Brady, Florence Momplaisir, Joshua P. Metlay, Alisa J. Stephens-Shields, Baligh R. Yehia

In AIDS Patient Care and STDs, Asher Schranz (New York University) and colleagues, including Baligh Yehia, compare HIV treatment outcomes for patients in hospital-based clinics versus those accessing care in a community clinic. The authors studied 2008-2011 data on HIV-infected adults in Philadelphia, assessing treatment outcomes in terms of retention in care, use of antiretroviral therapy, and viral suppression. Controlling for differences in patient and clinic characteristics, the authors find no difference in treatment outcomes between patients in hospital-based and community-based...